Journal of Research in Nursing and Midwifery (JRNM) (ISSN: 2315-568x) Vol. 2(8) pp. 114-121, December, 2013
DOI: http:/dx.doi.org/10.14303/JRNM.2013.064
Available online http://www.interesjournals.org/JRNM
Copyright ©2013 International Research Journals
Review
Midwifery and Midwives: A Historical Analysis
1
Najla Barnawi, 2Solina Richter and
*3
Farida Habib
1,3
College of Nursing-Riyadh, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
2
Faculty of Nursing, University of Alberta, Canada
*
Corresponding author email: fmh226@yahoo.com
Abstract
Midwifery, the first holistic profession in the world in which “care” has always been a women-centered
phenomenon. It is a socially constructed practice that has gone through many historical transitions.
Many of these have involved social controversies in terms of the meaning of care, the scope of its
practice, and its standardized skills. The purpose of this paper is to explore and critically examine the
major transitions on midwifery during history, looking in particular at the socio-cultural circumstances
that are associated with these transitions through an historical analysis. Two objectives are intended to
be explored; first, identify the major “macro” socio-cultural factors that shaped different meaning of
“concept of care” in midwifery. Second, identify the major “micro” socio-cultural factors that changed
the scope of practice in midwifery. Two main search approaches are used to collect the retrieved data;
textbooks searching, and computer searching. Textbooks searching phase aims to identify the
historical knowledge gap and different views of midwifery transitions based on four historical intervals
ranging from Stone Ages era to Early Modern time. Computer searching phase aims to critique the
different scholarly views that focus on the major social and cultural factors that shaped the practice
scope midwifery during history. During this strategy a comprehensive review of the major electronic
databases of MEDLINE, PubMed, and CINAHL was conducted. Midwifery is a woman-centered
phenomenon and a socially constructed practice where macro and micro socio-cultural factors played a
key role in its transition over the history. Power of social organizations, consistency of civilizations, and
productivity of industrialization are the major macro social factors that changed the concept of “care” in
midwifery from individualized concern to holistic approach. Gender identity, social class and authority,
and accessibility of formal education are the main micro socio-cultural factors that changed the practice
of midwifery from un-standardized practice to advanced scientific profession.
Keywords: Midwifery, History, socio-cultural factors
INTRODUCTION
Midwifery, the first holistic profession in the world, is the
art of providing supportive care for women during their
childbearing years (Lay, 2000; Leap and Hunter, 1993;
Marland and Rafferty, 1997). Traditionally, midwifery was
an unregulated practice in which females took the
initiative based on their societies inquiries (Leap and
Hunter, 1993; Marland and Rafferty, 1997). They were
primary healers, and they took on the role of nutritionists,
doctors, and spiritual advisors (Marland and Rafferty,
1997). Currently, midwifery is a profession that has a
regulated scope of practice (Lay, 2000; RCM, 2001; ICM,
2002). At present a midwife is a person who graduated
from an approved program that meets the essential
competencies of International Confederation of Midwives
(ICM, 2002). Midwives may practice in any setting that
includes home, community, hospital, clinic or health unit
(Royal College of Midwives, 2001; Barger, 2005).
Within the philosophy of midwifery, “care” has always
been a woman-centered phenomenon. The modern
model maintains the approaches of home birth, the social
aspects of giving birth, and the concept of holistic care
(RCM, 2001). It does so by providing preventative
measures, promoting normal and safe birth, detecting
maternal and child complications, and applying
emergency measures (Lay, 2000; RCM, 2001). As such,
it is a socially constructed practice that has gone through
Barnawi et al. 115
many historical transitions. Many of these have involved
social controversies in terms of the meaning of care, the
scope of its practice, and its standardized skills (Lay,
2000; Marland and Rafferty, 1997).
The purpose of this paper is to explore and critically
examine the major transitions on midwifery during history,
looking in particular at the socio-cultural circumstances
that are associated with these transitions through an
historical analysis. Two objectives are intended to be
explored; first, identify the major “macro” socio-cultural
factors that shaped different meaning of “concept of care”
in midwifery. Second, identify the major “micro” sociocultural factors that changed the scope of practice in
midwifery. In the current study four consecutive historical
periods, beginning with the Stone Ages, when midwifery
was an exclusive non-standardized female practice, to
the Modern era when midwifery has become a regulated
profession are going to be analyzed.
Midwifery during the Stone Ages
The Paleolithic, Middle Stone Age, & Neolithic
Periods (40,000 BC - 2000 BC)
Pregnancy and childbirth during the Paleolithic era were
processes that required women to survive labor in a hard
environmental lifestyle (Towler and Bramall, 1986).
Women supported themselves during birth based on
knowledge and skills they gained from observing other
mammals (Towler and Bramall, 1986; Englemann, 1882).
They prepared for labor by getting into a squatting
position,
cutting
the
umbilical
cord,
initiating
breastfeeding, and creating a warm and safe
environment for newborns (Towler and Bramall, 1986).
These basic techniques, which were based on
observational knowledge (Towler and Bramall, 1986;
Englemann, 1882), are compatible with the current core
concept of midwifery, which involves supporting a natural
and safe birth.
Both genders were involved in the tasks related to
care of pregnancy and childbirth. Each gender specific
role was based on the specific environmental
circumstances. For instance, during the Paleolithic era,
the male’s role focused on maintaining family security
while females gave birth and managed their labor (Towler
and Bramall, 1986; Graham, 1960). In contrast, during
Middle Stone Ages era (40,000 BC), the male’s role
became more inclusive because of the need to combine it
with long journeys. Men remained and provided help for
their partners particularly during labor (Towler and
Bramall, 1986; Graham, 1960).
During the Neolithic period, the male’s role was totally
excluded particularly during 10,000 – 8000 BC and it
continued to be the same thereafter for 10,000 years
(Towler and Bramall, 1986). Men’s role and energy in this
era mainly focused on the adjustment related to the
evolution of agriculture and associated
technology
(Towler and Bramall, 1986). As a results related to this
changes in the social organization, old women were the
main attendant at birth and gradually started fulfilling the
role of a midwife (Towler and Bramall, 1986). Their birth
experiences contributed to their skill and mainly focused
on maintaining a clean environment, providing oral
support, observing the progress of labor, receiving the
newborn, and cutting the umbilical cord (Englemann,
1882).
Evidence suggested that herbalism was fundamental
in providing perinatal care during this era (Marland and
Rafferty, 1997; Phillips, 2005). There was a limited
amount of herbs and natural resources; the knowledge of
how to choose, mix, prescribe and use these materials
were some the basic practices of a skilled midwife
(Ehrenreich and English, 2010). Adapting with and
surviving the difficult environmental circumstances were a
macro socio-cultural factor that shaped the primal
knowledge of midwifery care. Gender identity can be
described as the micro socio-cultural factor that shaped
the development of midwifery care during the Stone Age
era.
Midwifery in Ancient Times
Midwifery in the Biblical Eras (2200 BC – 1700 BC)
Midwifery during the biblical era was a respected social
practice performed by women of childbearing years
(Blickstein and Gurewitsch, 1998). Their role focused on
managing normal pregnancies and deliveries; they were
skilled in vaginal examination, and in defining the gender
of a fetus during breech presentations (Towler and
Bramall, 1986; Blickstein and Gurewitsch 1998; Liu,
1979). Midwives during the biblical era initiated the use
of birthing stool during delivery, and this practice
continued for 3300 years (Towler and Bramall, 1986;
Loose, 2008). Magic and witchcraft were practiced widely;
a religious man, the Rabbi usually attended birth only to
manage difficult cases; difficult delivery was seen as
caused by witchcraft or black magic and it was believed
that only the Rabbi could break this spell (Towler and
Bramall, 1986; Loose, 2008).
The biblical era was the golden period in the history of
midwifery in which women empowerment had an active
role in framing some concepts of professionalism in
midwifery. The existence of social class inequalities was
a major macro-social factor that empowered the role of
midwives (Towler and Bramall, 1986; Blickstein and
116 J. Res. Nurs. Midwifery
Gurewitsch 1998; Liu, 1979). For example, midwives
particularly supported women from the low class and
poor families (Towler and Bramall, 1986; Loose, 2008).
Further, they initiated the concept of family-centered care
by enhancing the husband and family participation during
birth (Towler and Bramall, 1986; Blickstein and
Gurewitsch 1998; Liu, 1979). In our view family-centered
care as a practice is one of the main approach of
professionalism in midwifery.
In addition religion, as a micro-social factor, led
midwives to advocate for social justice and protection of
minority women and their children. Monotheistic religion,
which was a belief of minority populations, led midwives
to overcome and challenge the political circumstances
that threatened them (Towler and Bramall, 1986;
Blickstein and Gurewitsch 1998; Zodak, 2010). A classic
example was when Shifra and Puah, the famous Hebrew
midwives, stood against the king’s declaration of killing
the Hebrews newborns (Towler and Bramall, 1986;
Zodak, 2010).
Midwifery during Egyptian Era (3500 BC – 100 BC)
Egyptian civilization and its social construction were the
main macro-social factors that shaped midwifery as a
unique, social and female vocation. It shaped midwifery
as an artistic and autonomous profession supported by
advanced and scientific knowledge (Towler and Bramall,
1986). Egyptian midwives were more clinically orientated
compared to midwives in the earlier eras (Towler and
Bramall, 1986).
They were able to determine the
expected date of delivery, describe different styles of
delivery chairs, and accelerate the delivery progress
(Towler and Bramall, 1986; Allen, 2005; Holmes and
Kilterman 1914; Nunn, 2002). Further, Egyptian midwives
were famous in prescribing herbs as drugs, and they
were aware of it’s pharmaceutical actions, particularly
during labor (Towler and Bramall, 1986; Allen, 2005;
Nunn, 2002). Male physicians, however managed the
complicated and high-risk deliveries (Towler and Bramall,
1986).
Religion and social class, which were constructed
based on political ranks (Towler and Bramall, 1986), are
the major micro-social factors that shaped Egyptian
midwifery. For-instance, women from privileged classes
such as royal families always gave birth in a royal birthhouses or centers that usually attached to temples
(O'Dwod and Philipp, 1994). In contrast, less privileged
women usually labored or birthed on cool house’s roofs
that were structured and decorated by papyrus-stalk
columns (Towler and Bramall, 1986). There is no
evidence addresses whether the women from poor
families or low social class, such as slaves, had been
labored or birthed in a specific religious places or even by
qualified midwives.
It is important to address that during Egyptian era and
in contrast with the Biblical era, social class inequalities
was a micro socio-cultural factor that promoted the social
image of midwifery rather than empowered the role of
women from macro-level perspective. Indeed, it
enhanced the scientific knowledge development in the
history of midwifery and it been recognized as a female
profession mainly among the midwives who provided
care for noble and upper classes women.
Gender is another micro socio-cultural factor that
provided deeper insight about the concept of
professionalism in the history of midwifery during ancient
Egyptian era. Evidence approves that there was no
gender inequalities or hierarchal authority had been
appeared between male and female professionals during
this era. This implies that midwives, herbalists, and
physicians worked collaboratively based on their
specialities (Towler and Bramall, 1986). It seems that the
Egyptian social construction of gender identity introduced
the notion of gender professionalism in the medical field
in general, and on midwifery in specific. Further, it
created different meanings of “care” during pregnancy
and birth based on the abilities of each gender.
For-example, female midwives usually managed
normal or low risk pregnancies, and minor gynecological
problems cases (Towler and Bramall, 1986). Being a
female and sharing the same gender identity led the
midwives to provide care with empathy and more
sensitive approaches that compatible for female’s needs.
Whereas,
male
physicians
managed
complex
pregnancies that had pathological situations, or cases
that required surgical operations (Towler and Bramall,
1986). Being a male allowed the physicians to provide
care with less empathy and more invasive approach
mainly to maintain the life surviving for both the mother
and her fetus. While, the herbalists, mainly females,
provided clinical support as needed for both midwives
and physicians (Towler and Bramall, 1986). This implies
that care in pregnancy and birth is a value that had
different views during this era and it was based on the
gender identity and their clinical backgrounds.
Midwifery during Greco-Roman Era (500 BC to 400
AD)
The Greek civilization, which we consider it as one of the
major macro-social factor during that era, shaped
midwifery as an art and a scientific profession (Towler
and Bramall, 1986). It was functioned as respected,
social, autonomous, and paid vocation for women (Leap
and Hunter, 1993; Towler and Bramall, 1986; Arvanitidou,
2009; Grant and Carter, 2004). The traditional Greek
ancient practices of midwifery were religiously beliefs and
Barnawi et al. 117
socially ranked (Marland and Rafferty, 1997; Towler and
Bramall, 1986). For instance, during 500 BC, midwives
ranked into; firstly, consultant midwives who managed
difficult and critical cases. They usually had a religious
character and a strong faith, wide social contribution, and
strong clinical background (Leap and Hunter, 1993;
Marland and Rafferty, 1997; Towler and Bramall, 1986;
Arvanitidou, 2009; Grant and Carter, 2004). Secondly,
practiced or herbalist midwives who usually attended the
normal births (Leap and Hunter, 1993; Marland and
Rafferty, 1997; Towler and Bramall, 1986). They had to
be a decent woman, born children herself with a positive
outcome, and knowledgeable about the different types of
herbs that may used during birth (Leap and Hunter, 1993;
Marland and Rafferty, 1997; Towler and Bramall, 1986).
This social classification highlight that the religion and
social class were the major micro-social factors that
shaped the role and the clinical knowledge of the
midwives during this era. In addition, it seems that the
“herbalist-midwives” was established during Greek era as
a sub-classification of the midwifery profession. Further,
this classification raises an important question about the
role of the male physicians during this era. Evidence
suggested that they were just intervening in breech
presentation pregnancies or cases that were required
internal operations. Towler and Bramall, 1986).
During the Roman era, herbalism developed
considerably and became more scientifically oriented
profession compared to midwifery, which had a very little
scientific contribution (Lay, 2000; Louros and Kairis,
1951). The reason of this variation is unknown; however,
evidence addressed that herbalism, became a male
domain practice. (Lay, 2000). It is reasonable to assume
that there is a strong connection between gender identity
and increasing the scientific knowledge in general during
this
era.
Conversely,
the
real
socio-cultural
circumstances that justify this assumption are unclear
and not been discussed.
In contrast, the scientific knowledge of midwifery was
retrieved from the Egyptian literature (Towler and
Bramall, 1986; Arvanitidou, 2009; Grant and Carter,
2004). Inasmuch as, midwives built up their skills from
midwifery’s experts who were usually females Towler and
Bramall, 1986; Arvanitidou, 2009). The ruling class and
gender inequalities (Towler and Bramall, 1986). were the
major micro-social factors, diminished the development of
the scientific contribution in midwifery and its practice.
Evidence suggested that the formal education was
available only for men and the noble class “mothers”
(Lay, 2000; Towler and Bramall, 1986; Louros and
Kairis, 1951). Therefore, lay female herbalists and
midwives persecuted from accessing the formal
educational system, and they were not socially accepted
compared to the Greek era and sustained likewise for two
centuries (Towler and Bramall, 1986; Arvanitidou, 2009;
Louros and Kairis, 1951).
In late 300 BC, the social attitudes about female
midwives and herbalists changed radically (Marland and
Rafferty, 1997; Towler and Bramall, 1986).
Many
feminism movements empowered the roles of female
midwives and herbalists who fought against gender
inequalities to promote their scientific knowledge
(Marland and Rafferty, 1997; Towler and Bramall, 1986).
For instance, Agnodike, who introduced “men-wives” and
practiced as a male obstetrician (Towler and Bramall,
1986), was one of the pioneers that introduced science in
midwifery (Towler and Bramall, 1986; Arvanitidou, 2009;
Grant and Carter, 2004). Agnodike charged for illegal
practice of midwifery as a female (Towler and Bramall,
1986). She allowed to practice midwifery as an
obstetrician after won the appealing round that performed
by a group of women. (Towler and Bramall, 1986).
Philista, known later on as a popular professor in
medicine, was another example who promoted the
scientific knowledge in herbalism as medicine (Grant and
Carter, 2004). She provided lectures behind a curtain, to
prevent her beauty from distracting her students (Grant
and Carter, 2004). Regardless to the challenges that
these women faced; midwifery became more scientifically
approach. In contrast with the Egyptian era, midwifery
became a scientific profession under the hierarchy of
medicine that supervised by male physicians.
The Byzantine Era (400 AD – 600 AD)
Byzantium was a highly organized society and had
advanced governmental and social services. (Towler and
Bramall, 1986; Grant and Carter, 2004). Development of
the formal social organizations and public healthcare
services were influential macro-social factors that
regulated midwifery as a formal profession. For-instance,
initiating the “hospital-hotels” notion as a public
healthcare services shaped midwifery as a valued social
profession for women. (Towler and Bramall, 1986;
Arvanitidou, 2009; Parker, 1997). Further, evidence
inferred that the first midwifery hospital developed during
this era; they managed by and for women (Towler and
Bramall, 1986; Parker, 1997). Islam, as a micro-social
factor, empowered the women’s role in midwifery and
maintained the concept of women-centeredness (Towler
and Bramall, 1986; Grant and Carter, 2004).
The advanced social organization during that era had
a positive impact on shaping midwifery as a profession
regulated within the health care system; though, the
scientific knowledge and clinical standards of midwifery
did not improve during this era. Evidence suggested that
midwifery during this era retrieved from Roman’s culture
(Towler and Bramall, 1986; Arvanitidou, 2009).
This indicates that midwifery practiced in unscientific
118 J. Res. Nurs. Midwifery
approached and had no further clinical contribution
(Towler and Bramall, 1986).
There was gender inequality with respect to formal
education programs and payment rewards, which
privileged men but not women (Towler and Bramall, 1986;
Arvanitidou, 2009; Grant and Carter, 2004; Parker, 1997).
However, the existence of the healthcare system and
organized social services led midwives to provide their
services in a competent and standardized manner, but
without any formal education or training program (Towler
and Bramall, 1986; Parker, 1997).
profession of physicians (Towler and Bramall, 1986;
Ehrenreich and English, 2010).
In addition, gender inequalities that prevented women
from formal education and hob opportunities played on
marginalizing midwives. For-instance, Jacoba Felicie,
who was a skilled French midwife and healer, in 1322
legally denounced for practicing medicine and midwifery
without licensing (Ehrenreich and English, 2010). This
indicates that the patriarchal authority and masculinity
movements had a direct impact on shaping midwifery
more as medicalized interventions during Dark Ages.
Dark Ages & Middle Ages Era (5th Century to 15th
Century)
Modern Era
Early Middle Ages (5th Century to 11th Century)
Religion, specifically Christianity, was the main social
factor that constructed the social life during Dark Ages,
and this included the healthcare services (Marland and
Rafferty, 1997; Towler and Bramall, 1986). This indicates
that midwifery was a valued and religiously respected
profession. Evidence suggested that women can only
practice midwifery when priests declared and
acknowledged their religious and moral status (Marland
and Rafferty, 1997; Towler and Bramall, 1986). In some
cultures, nuns practiced midwifery as a religious
obligation (Marland and Rafferty, 1997), and they known
as "occupational female doctors"(p.12) (Towler and
Bramall, 1986). Because of the existence of gender
inequalities in terms of education and job opportunities
(Towler and Bramall, 1986; Ehrenreich and English,
2010), midwives did not attain any formal educational or
training program (Ehrenreich and English, 2010). Their
roles focused on assessing and managing pain during
labor, and on maintaining hygienic and comfort status for
mothers and their newborns (Towler and Bramall, 1986;
Hughes, 1952).
High Middle Ages (12th Century to 16th Century)
Throughout the UK, Europe, parts of North America, and
Scotland, midwives were socially marginalized and totally
excluded (Towler and Bramall, 1986; Forbes, 1966;
Marland, 1993). Many female healers and midwives
sanctioned and tortured by burning or hanging as
heretics or witches (Towler and Bramall, (1986); Forbes,
(1966); Evenden, 2000). These criminals carried out
based on the authority of the king and medieval church to
suppress the competition of the new male medical
Midwifery and Men-Wifery (17th Century to 18th
Century)
Throughout seventeenth and eighteenth centuries, the
booming of surgical instruments and institutional medical
training introduced males in midwifery (Men-Wifery). Forinstance, in the seventeenth century, barber-surgeons
also known as forceps-men, attended many births mainly
to manage difficult and hopeless cases (Kontoyannis and
Katesetos, 2011; Stern and Facog, 1972). Therefore,
they were socially neglected and perceived as
misfortunate attenders (Kontoyannis and Katesetos,
2011; Casssidy, 2006).
In 1750s, male midwives
involved in midwifery license system (Kontoyannis and
Katesetos, 2011; Casssidy, 2006). Though, they were
controversial and questionable at the onset, and they
viewed as deviant, improper, and scandalous (Ehrenreich
and English, 2010). This social perception changed
radically because of the positive reputation that they
made in managing normal deliveries with live and healthy
newborns (Kontoyannis and Katesetos, 2011).
In early eighteenth century, the rate attendance of
men-midwives increased; therefore a classification
system designated women who attended the birth as
midwives while men as obstetricians (Evenden, 2000;
Stern and Facog, 1972). They were academically
privileged compared to female midwives as they
perceived formal education and training (Kontoyannis
and Katesetos, 2011). Their advanced skills in utilizing
the instruments during labor and their qualifications
signified the scientific development in midwifery
(Kontoyannis and Katesetos, 2011). There are clear
accounts that male midwives went to great extremes to
respect modesty and reduce embarrassment (ICM, 2002;
Nicopoullus, 2003). When a male midwife called to a
birth, he would often drape women, tying the long cloth
around his own neck; so that his eyes could not see what
Barnawi et al. 119
his hands were doing (Towler and Bramall, 1986; Stern
and Facog, 1972; Pilkenton and Schom, 2008).
Midwifery and Nursing during the Modern Period:
Regulatory Professions
United Kingdom and Europe
It seems that nursing was a demanded profession in UK
and European countries rather than midwifery because
the absence of regulated health care system (Towler and
Bramall, 1986). Many bills were introduced to regulate
nursing as a regulated profession, and considering
midwifery under its scope of nursing (Leap and Hunter,
1993). For-instance, in United Kingdom (1887),
established British Nurses’ Association [BNA] to regulate
the scopes of nursing and midwifery based on medical
systematic training programs (Leap and Hunter, 1993;
Evenden, 2000). The focus was to maintain the public
safety and protection (Leap and Hunter, 1993; Evenden,
2000). In 1902, Midwives Registration Act Bill was
reintroduced to consider midwifery and nursing as
separate professions, but was refused (Leap and Hunter,
1993). In 1903, the House of Commons Select
Committee accepted nursing registration but not
midwifery (Leap and Hunter, 1993; Marland and Rafferty,
1997).
The Midwifery Act accepted in 1952, and the Central
Midwives Board (CMB) was established to regulate the
midwives registrations (Marland and Rafferty, 1997;
Towler and Bramall, 1986; (CMB, 1953). In March 31st of
1952, CMB removed the Society of Apothecaries and
Queen’s Institute of District Nursing from their committee
board (CMB, 1953). Though, the Royal College of
Obstetricians and Gynecology became an appointing as
a co-supervisory regulatory body in CMB (CMB, 1953).
Regardless to the limited scope of practice of midwifery,
there were 17.512 women attained to practice; 4531
regular students and 4253 registered nurses trained and
graduated as pupil-midwives (CMB, 1953). Indeed, the
act developed the midwifery teacher’s skills by offering
Midwifery Teacher Diploma Examination and Midwifery
Teachers Training College (CMB, 1953).
USA and Canada
In 1915, traditional midwifery was disappeared in
American society, and it usually was practiced by
foreigners with different ethnic background and in few
areas in USA (Cutter and Viets, 1965; Hiestand, 1977).b
They were practicing based on their experiences
andwithout formal education or training or qualifications
(Cutter and Viets, 1965; Hiestand, 1977). However, Mary
Breckinridge in 1920s introduced a British nurse-midwife
model in American society (MacDorman and Singh,
1998). In 1925, she upgraded the model to include the
concept of Frontier Nursing Service (FNS) (Breckinridge,
1952). FNS focuses on creating Community Based
Nurse-Midwifery Education Program (McDonald and
Blogger, 2011).
This model, which still exists, maintains the role of
midwifery in the community and supports the public
health nursing (Parkland Memorial Hospital, 2000;
Plummer, 2000). The main focus was promoting the
public hygienic level, providing accessible prenatal care,
and initiating home visits (Hiestand, 1977;National
Aboriginal Health Organization, 2004). Nurses-midwives
in this model were able to mange normal and low
complicated pregnancies (MacDorman and Singh, 1998;
McDonald and Blogger, 2011). Based on the evidences,
this model had a positive impact on the American
midwifery (MacDorman and Singh, 1998; McDonald and
Blogger, 2011). For instance, the maternal mortality rate
was decreased, and the medical outcomes were
impressive in light of the socioeconomic status
particularly in Appalachian (Breckinridge, 1952; Relyea,
1992).
In Canada, midwifery was reintroduced as a regulated,
autonomous, publically funded profession in most
provinces during the 1990s (Benoit and Carol, 2005;
Plummer, 2000). The experiences of midwives are
essential in the Canadian midwifery. Therefore, midwives
who practiced prior the legislation were required to
submit a portfolio that meets the regulatory requirements
(Benoit and Carol, 2005). Midwifery education and
training is a main concern in Canada; it has various types
of education programs that meet the approaches of home
birth and social aspects of giving birth. For-example,
direct entry programs of baccalaureate degree in
midwifery exist in six provinces (Benoit and Carol, 2005;
Relyea, 1992). Furthermore, there are three aboriginal
midwifery education programs, some based on
apprenticeship models (National Aboriginal Health
Organization, 2004; O’Brien, 2012). The main aim of
midwifery in Canada, is maintaining globalization in
midwifery and sustaining the traditional aspect of giving
birth such Inuit midwifery (O’Brien, 2012). The current
legislation of midwifery in most Canadian provinces
brought midwives into the mainstream of healthcare with
universal funding for services (Bourgeault et al., 2004;
Fleming, 1994).
CONCLUSION
Midwifery is a woman-centered phenomenon that
contextualizes the care as a holistic approach that
maintains social and cultural aspects of giving birth.
We critiqued five historical eras and articulated the major
120 J. Res. Nurs. Midwifery
social and cultural circumstances that are associated with
midwifery transitions. We conclude that midwifery is a
socially constructed practice where macro and micro
socio-cultural factors played a key role in its transition.
Power of social organizations, consistency of civilizations,
and productivity of industrialization are the macro social
factors changed the image of midwifery from a social
practice to be more qualified and regulated profession.
However, gender identity, social class and authority,
knowledge awareness and accessibility of education are
the significant micro socio-cultural factors that influence
the concept of care in midwifery. These macro and micro
social factors are correlated to each other, though it
seems that each played a main role based on specific
periodic time.
Midwifery in our view is an art and humanized practice
that deals with pregnancy and childbirth as a social
event. This requires midwives as well as a society to
understand that midwifery considers the social and
cultural aspects of perinatal care. This is the main
difference between being a midwife or an obstetrician.
We are acknowledging the role of obstetric on managing
the complicated or high risky cases, but it contrast with
the approaches of midwifery.
Finally, we highly
recommend re-introducing the historical, social, and
cultural aspects of midwifery to maintain the views of
globalization in midwifery.
Funding: This article received no specific grant from any
fading agency in the public, commercial, or not for profit
sections.
Inflect of interest: Researchers declare no conflict of
interest with any organization regarding the materials
discussed in this manuscript.
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How to cite this article: Barnawi N, Richter S and Habib F (2013).
Midwifery and Midwives: A Historical Analysis. J. Res. Nurs.
Midwifery 2(8):114-121